The Down's Syndrome Neurocognitive Change Monitoring Framework (DS‐NCMF): A Clinical Reasoning Framework for Emerging Neurocognitive Change

Background Adults with Down's syndrome face a high lifetime risk of Alzheimer's disease, yet existing assessment instruments and clinical guidance do not structure how longitudinal caregiver observations are interpreted and acted upon before formal specialist assessment. Method This conceptual paper draws on current evidence relating to dementia in Down's syndrome, clinical guidance and emerging biomarker developments to describe the theoretical foundations and architecture of the Down's Syndrome Neurocognitive Change Monitoring Framework (DS‐NCMF). Results The DS‐NCMF comprises four interconnected stages, Recognition and Monitoring, Baseline‐Relative Interpretation, Differential Assessment, and Decision‐Making and Response, providing a structured approach to generating, interpreting and responding to longitudinal observational information within routine intellectual disability services. Conclusion The DS‐NCMF addresses an implementation gap between existing guidance and routine practice, offering a foundation for future feasibility, implementation and effectiveness research within intellectual disability services.